Ebola - a risk for Europe?

26th of March 2015

Are medical professionals in Europe concerned about the risks of Ebola? How easily is it spread, and is it on the radar of those European companies serving the healthcare sector? ECJ takes a closer look at Ebola and finds out what is being done to keep it away from Europe’s shores.

Over the past 12 months the world has been facing the largest known outbreak of Ebola in its history. Research scientists have been racing against time to control the spread of the deadly disease which has claimed thousands of victims since the crisis began in March 2014.

The virus is mostly confined to three nations - Liberia, Sierra Leone and Guinea - though outbreaks have been reported in other countries including Mali. But its tentacles are reaching far beyond the African continent and into other areas of the world - even Europe. We are all holding our breath and waiting for news that Ebola has been spreading on our shores.

In fact Europe has already seen a sprinkling of Ebola cases, mainly due to the fact that large numbers of brave healthcare workers have been travelling to affected countries to help fight the spread of the virus. Inevitably, some of these people have been infected themselves.

In January this year, 39-year-old Ebola victim Pauline Cafferkey from South Lanarkshire in Scotland was being treated with an experimental anti-viral drug at the Royal Free Hospital in London. Cafferkey became critically ill after contracting Ebola when working with the Save the Children charity in Sierra Leone.

Italy had its first Ebola patient in November 2014. A 50-year-old Sicilian doctor contracted the disease while treating the sick in Sierra Leone. He was vaccinated with an experimental vaccine at a hospital in Rome.

In October, four people in Spain were taken to hospital after a Spanish nurse became the first person known to have contracted the virus outside Africa. The World Health Organisation (WHO) then warned that the spread of Ebola across Europe was unavoidable.

And in September, British nurse William Pooley recovered from the disease after being treated at the Royal Free Hospital in London. He was given the anti-viral drug ZMapp of which there are no stocks left anywhere in the world.

But we are constantly being reassured that the risk of contracting the disease in Europe is minimal. WHO regional director for Europe Zsuzsanna Jakab has claimed European countries are among the best prepared in the world to respond to viral haemorrhagic fevers such as Ebola, and that the risk of Ebola spreading in Europe is both avoidable and extremely low.

However she adds that travel between Europe and affected countries make sporadic cases of Ebola in the WHO European region unavoidable, though strict infection control measures should be used to mitigate this risk.

In the UK, meanwhile, chief medical officer Professor Dame Sally Davies has posted a video on YouTube predicting that the country will see “up to a handful of cases”. The video aims to reassure the public about NHS preparedness for Ebola and Dame Sally claims that hospital trusts have procedures and protocols in place to safely treat victims.

But none of these reassurances is sufficient to completely suppress the current climate of fear. On a recent visit to my own doctor’s surgery in the UK I spotted a sign on the wall aimed at medical staff that seemed to be designed to reassure on one hand and terrify with the other.

The sign confirmed that an outbreak of Ebola in the UK was highly unlikely and that Ebola victims were not contagious in the early stages of the disease. However, it added that doctors should be alert to signs of fever from anyone who had recently returned from Liberia, Sierra Leone or Guinea. And despite previous reassurances about the unlikelihood of contagion it urged staff to have no physical contact whatsoever with such a patient.

This appears to be the general take on Ebola. We know it is only contagious via bodily fluids and it is mostly confined within a few African countries. But we also know how terrible and life-threatening it is. And we are aware of the fact that people are travelling overseas all the time.

All the major health organisations offer advice and guidelines for treating Ebola and preventing its spread to others, while also highlighting the level of risk the virus poses. The WHO states that healthcare workers treating cases of Ebola should wear personal protective equipment to shield the mouth, nose and eyes from contaminated droplets and fluids. Hand hygiene and the use of gloves are considered essential by WHO to protect the healthcare worker and to prevent transmission of the Ebola virus to others.

The position of Public Health England is to reassure us about the low risks of the disease outside of Africa. In its guidance document it claims the most severely affected countries have weak health systems with poor infrastructural resources since they have only recently emerged from periods of conflict and instability.

However, it claims that healthcare workers run the risk of becoming infected when they come in close contact with patients without practising strict infection control precautions. Burial ceremonies in which mourners have direct contact with the body of a deceased person can also play a role in the transmission of Ebola in Africa.

Advice from the European Centre for Disease Prevention and Control is more specific – and rather more reassuring. It provides detailed information on the riskier pursuits and claims that the likelihood of infection with the Ebola virus is low, even among those living in or travelling to affected areas.

The organisation reiterates transmission can only be caused via direct exposure with the bodily fluids of infected persons or animals, either dead or living. But unprotected sexual contact with an Ebola patient is considered a risk even up to three months after the patient has recovered.

“You cannot contract Ebola virus by handling money, groceries, or swimming in a pool,” claims the European Centre for Disease Prevention and Control. “The Ebola virus is easily killed by soap, bleach, sunlight and high temperatures or drying. Machine washing clothes that have been contaminated with fluids will destroy the virus, which survives only a short time on surfaces that are in the sun or have dried.”

However, the virus can survive for longer periods on clothes or materials that have been stained with blood or other bodily fluids. ?And there is a risk of transmission of Ebola through contact with utensils or contaminated materials in a healthcare setting if the correct infection control procedures have not been followed.

Some companies claim to have noted an increased interest in support for infection prevention measures in the wake of the Ebola crisis. According to Diversey Care global marketing director for infection prevention Hans de Ridder, even companies outside the healthcare sector are increasingly looking for enhanced infection control solutions.

“In particular we are seeing an increase in demand for specialist products such as our Oxivir Plus spill kit,” he said. “This enables customers to remove a body spill quickly and effectively. Body spills and unexpected soiling always represent a potential source of infection and must be cleaned up quickly to eliminate the risk.”

Healthcare facilities have an advantage in that they are generally geared up to deal with the threat of new and evolving pathogens, says de Ridder, and they also have the knowledge, tools and resources to do so.

“However, many other businesses that cater to the public such as hotels, schools, restaurants, airports, shopping malls and cruise ships have fewer resources and less internal knowledge to apply to protecting their customers from infection,” he adds. “They also often have minimal infection prevention regulation and they rely on public health officials or other external resources for assistance.”

The company offers support material for customers that can be downloaded on www.diversey.com/ebola. “This material reflects the recommendations of the WHO and CDC,” said de Ridder. “We are emphasising the importance of hand hygiene to prevent the spread of Ebola.”He adds that infection prevention should always be uppermost in the minds of any organisation that welcomes guests, cares for vulnerable people, wants to protect its own employees or has a general ‘duty of care’ for others.

“In reality the majority of common and emerging pathogens can be prevented and eliminated with simple and effective cleaning and hygiene processes,” he said. “We will continue to work closely with our customers to support their infection prevention programmes, help them introduce and improve the most effective processes and assist them in selecting products.”

Gojo Europe’s managing director Mike Sullivan says his company is also seeing an increased demand for hand hygiene solutions. “The main risk is in the healthcare sector, but organisations in general are becoming increasingly aware that hand hygiene is essential.”

The company claims its Purell hand rub helps reduce the risk of transmitting germs via the hands while also complementing routine hand washing regimes. “In addition we provide training and support to encourage hand hygiene best practice and we work closely with the WHO through our membership of Private Organisations for Patient Safety.”

According to Sullivan, the current outbreak serves as a timely reminder of the crucial role that hygiene plays in reducing the risks of infections spreading. “This is not only important in hospitals and other healthcare environments, but also in the food sector, education and the general workplace where the highest standards of hygiene should constantly be delivered.”

Ebola has been around since 1976 when it first emerged in Sudan and Zaire. More than 280 people were affected in that outbreak, over half of whom died. Nearly 40 years on it seems unlikely that the disease will be completely eradicated in the foreseeable future. But hopefully with continued investment in research and an increasing understanding of the properties of the virus, Ebola will be brought under control before too long.